AB0319 PREALBUMIN SERUM LEVEL AS A USEFUL TOOL IN THE ASSESSMENT OF MALNUTRITION IN ELDERLY PATIENTS WITH RHEUMATOID ARTHRITIS
Authors: M. Ardhaoui, J. Mahbouba, F. Naffati, F. Fhima, M. Ghali, S. Zrour, I. Bejia, M. Touzi, N. Bergaoui
Journal: Annals of the Rheumatic Diseases (2022)

Background Protein-energy malnutrition is a common condition among elderly patients with RA associated with a poor prognosis. Although many screening tools are developed, there’s no consensus on which test is more reliable in clinical practice. Serum prealbumin (PAB) may be a useful malnutrition biomarker. Objectives Our objective is to evaluate the usefulness of serum PAB in the assessment of malnutrition in elderly patients with RA. Methods We conducted a prospective study including RA patients who were followed in rheumatology department and aged 65 years or older. We studied malnutrition prevalence, risk of complications related to malnutrition and PAB serum concentrations. The mini-nutritional assessment (MNA) score was used as the reference method to determine malnutrition. We also dosed inflammatory proteins: Orosomucoide (Oroso), C-reactive protein (CRP) and Haptoglobine (Hapto). For the prognosis assessment, we calculated the Geriatric nutritional risk index (GNRI) and the Prognostic Inflammatory and Nutritional Index (PINI). Results Sixty-three patients (52 female and 11 male) were included. Their mean age was 68.17±4.35 years. The average DAS28 was 3.72±1.48. The mean MNA total score was 20.19 ± 4.71. According to MNA, the prevalence of malnutrition was 20.6%. 55.6% of the patients were at risk of malnutrition and only 23.8% of patients had a normal nutritional status. The median PAB was 0.16 g/L with an IIQ of [0.04-0.24] and extremes ranging from 0.01 to 0.37 g/L. According to PAB, 35.8% of patients had a normal level above 0.20 g/L, 17% had PAB levels between 0.15 and 0.19 g/L, indicating moderate malnutrition and 47.2% of patients had PAB levels below 0.15 g/L, indicating severe malnutrition. Concerning inflammation proteins: the mean CRP was 18.96 ± 27.8 mg/L. 28.6% of patients had a CRP &gt; 15 mg/L, of which 9.5% had a CRP &gt; 50 mg/L. The mean Oroso was 1.29 ± 0.46 g/L [0.6-2.2]. 52.5% of our patients had an elevated oroso value. The mean Hapto was 2.07 ± 0.97 g/L [0.31-5.29]. 42.9% of patients had an increased value above 2.5 g/L. Concerning prognosis indexes, the median GNRI was 116.47 with an IIQ of [106.6-125.12] and extremes ranging from 70.06 to 145.02. The median PINI was 1.77 with an IIQ of [0.47-10.21] and extremes ranging from 0.05 to 222.16. Statistical analysis showed a significant association between PAB and MNA with p=0.05. Negative correlation was found between PAB and inflammatory proteins; with Oroso (p=0.001), CRP (p=0.006) and Hapto (p=0.03). By analysing prognosis indexes, significant negative correlation of the serum PAB was found with the GNRI (p=0.003) and the PINI (p=0.001). Conclusion We conclude that PAB could represent a feasible and reliable tool in the diagnosis of malnutrition. It is a good biomarker for the prognosis and the assessment of the risk of complications related to malnutrition among the elderly patients with RA. Disclosure of Interests None declared